Bush Weighing Plan to Offer Smallpox Vaccine to the Public

Inoculations would be voluntary. They might not be available until early 2004, though some in the administration want to move faster.

WASHINGTON — President Bush is moving toward approving a plan to eventually offer the smallpox vaccine to all Americans, starting with health-care workers most likely to come into contact with a contagious patient, administration officials said Thursday.

He has not, however, signed off on key details or a final plan.

Bush is closer to a decision on shots for the military. Officials said he is inclined to approve a blueprint for vaccinating some U.S. troops against the disease, which was eradicated two decades ago but could return in biowarfare.

Bush's top bioterrorism aides agree that the vaccine should eventually be offered to the public, and officials said Thursday that Bush is comfortable with that plan. At issue is how fast to move ahead.

A once-feared disease, smallpox historically killed 30% of its victims. The virus also could be a powerful weapon. It is highly contagious and has no known treatment. Routine vaccinations in the United States ended in 1972, making the population highly vulnerable to an attack.

But the vaccine, made from a live virus, is also dangerous. Health experts estimate that one or two of every million people vaccinated for the first time will die, and about 15 others will suffer life-threatening side effects.

Under the proposal for the military, the first personnel to receive the vaccine would be "first responders" -- troops responsible for assisting in domestic disasters, such as a bioweapons attack. They include medical specialists.

As many as 500,000 troops might eventually be inoculated, senior defense officials have said. Of the 1.4 million men and women in the active-duty military, fewer than half have ever received the smallpox vaccine.

Bush is moving toward smallpox decisions as a prelude to possible war with Iraq, which U.S. intelligence officials believe has smallpox samples.

Amid heightened concerns, the Pentagon is pushing to provide every available form of protection for troops who might be exposed to germ weapons in Iraq or elsewhere. Unlike the civilian vaccination program, which would be entirely voluntary, troops would be required to get the shots.

Vice President Dick Cheney, a former Defense secretary, is among those who have pushed most aggressively for protecting the military and the general civilian population against smallpox attacks.

Bush has postponed announcing a decision on vaccinating the civilian population until after he returns from a NATO summit in Europe on Nov. 23. Aides said they did not know when he would disclose his decision on vaccinating troops.

For the civilian population, top health officials favor offering the shots first to people on special smallpox response teams and to those who work in emergency rooms. Next would be about 10 million others, including emergency responders and other health-care workers. Eventually, the vaccine would be offered to the public, though not until there was enough FDA-approved vaccine available, probably in early 2004.

Some in the White House favor moving ahead more quickly, offering it to the public even before FDA approval.